Cost projections for oral non-peptide GLP-1 agonists — anyone have experience?

DanielChem_CHI said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. Small molecule does not automatically mean cheap. Price is set by what the market will bear and by patent life, not by cost of goods, and I would not assume the savings reach patients.

Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

Adding the numbers, since they settle part of this. Practical: whatever you change, write down the date and the reason. In three months the reason is what you will have forgotten, and the reason is what makes the record worth having.

LipidDoc_ATL said:

Small molecule does not automatically mean cheap.

Adding the part of the answer the thread has not reached. It is worth asking what the claim would look like if it were false. If nothing would look different, it is not a claim about the world and no amount of discussion will settle it.

Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

One thing that is still open after sarah_TO’s answer:

What actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work?

OP back with an update, since a thread like this is useless without one.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.